The Rosewood Medical Centre

We carried out an announced comprehensive inspection at Rosewood Medical Centre on 15 July 2019, to follow up the breaches of inspection found in the inspection of 11 December 2018 .

We based our judgement of the quality of care at this service on a combination of:-

• what we found when we inspected,
• information from our ongoing monitoring of data about services,
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice had made significant improvement to the practice in response to the previous inspection.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice had improved access for patients to the practice.
• The practice had refurbished the premises to ensure they met the needs of the patients.
• Complaints were listened and responded to and used to improve the quality of care.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was compassionate, inclusive and effective leadership at all levels.

Whilst we found no breaches of regulations, the provider should:

• Review the training matrix regularly to ensure all staff, including doctors have completed the necessary training.
• Review the clinical meetings to ensure frequency and that staff record discussions.
• Review the supervision of advanced medical and nursing practitioners to ensure that it is fully recorded and follows current guidelines.
• Continue to improve the uptake of child immunisations to meet the World Health Organisation targets of 90%.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care.

We carried out an announced comprehensive inspection at Rosewood Medical Centre on 11 December 2018 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:-

• what we found when we inspected,
• information from our ongoing monitoring of data about services,
• information from the provider, patients, the public and other organisations.

The overall rating for this practice was requires improvement due to concerns in providing safe and well-led services. However, the population groups were rated as good because patients were provided with effective care and treatment, treated with kindness and respect and were able to access timely and effective care and treatment.’

We rated the practice as requires improvement for providing a safe service because:

• At the time of the inspection the practice did not have a safe system in place for the receipt and management of medical documents and test results.
• At the time of the inspection, the practice did not have a health and safety or premises risk assessment in place to demonstrate the assessment and mitigation of risk to both patient and staff.
• The practice did not have a safe system in place to ensure action for patients whose treatment may have been affected by safety alerts from the Medicines and Healthcare Product Regulatory Agency.

We rated the practice as requires improvement for providing a well-led service because:

• The overall governance arrangements were sometimes ineffective. This had resulted in staff not completing the necessary training and a lack of protocols for staff to follow to ensure a consistent approach.
• At the time of the inspection the practice did not have a system in place to manage the global inbox of patient documents and test results to ensure a prompt response.
• At the time o the inspection, the practice did not have a health and safety or premises risk assessment in place to identify and mitigate any risks to patients and staff.
• Staff were unclear about how their roles and responsibilities linked to other members staffs work and how they were reflected in the protocols. Such as during the management of safety alerts.
• Some policies and procedures did not fully reflect the staff practices. For example, the policy.
• Further improvements were required to ensure the practice successfully sought patient views regularly.

We rated the practice as good for providing effective, caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice had clear systems, practices and processes to keep people safeguarded from abuse.
• The practice had systems in place for the appropriate and safe use of medicines.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice had improved access for patients to the practice.
• Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
• The practice had a comprehensive programme of quality improvement, they actively and routinely reviewed the effectiveness of the care provided.
• The practice had refurbished the premises to ensure they met the needs of the patients.
• Complaints were listened and responded to and used to improve the quality of care.
• There was compassionate, inclusive and effective leadership at all levels.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review staff training to ensure they completed the necessary training for their role.
• Review the identification of carers to enable this group of patients to access the care and support they need.
• Review the blind cords at the window in reception are made safe and adhere to the safety alert raised 8 July 2010 Gateway Reference: 14535.
• Review patient feedback to ensure it is sought regularly.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rosewood Medical Centre on the 25 March 2015. Overall the practice is rated as Good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people, people with long term-conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to staff training in infection control and non-clinical staff training in safeguarding adults and children.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had not always received training appropriate to their roles and any further training needs had not been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

In addition the provider should:

• Ensure all staff receives appropriate training in infection control and all non-clinical staff receives  training in safeguarding adults and children.
• Ensure a Legionella risk assessment is completed to reduce the risk of infection to staff and patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice